Patient Medication Counselling for Pharmacists
- : Online
As articulated by the World Health Organization, community pharmacists are the health professionals who are most accessible to the public. Integral to the pharmacy profession is a commitment to promoting health awareness in the community (WHO n.d.).
Pharmacists can directly influence positive outcomes for patients by educating and counselling them to assist their compliance to their pharmacotherapeutic regimens and monitoring plans (ASHP 2011).
To provide effective pharmaceutical care, a pharmacist needs to acknowledge the responsibility they have in a patient’s pharmacotherapeutic outcomes.
- ‘Patient counselling provides an opportunity to elicit the necessary information from a patient, and to enable safe and effective use of medicines. Patients have the right to expect that the pharmacist will counsel them privately about their medicines … Counselling is also the final checking process to ensure the correct medicine is supplied to the correct patient.’
(Pharmacy Board of Australia 2015)
Providing counselling and information for safe and effective medication management is directly tied to Domain 3: Medicines Management and Patient Care of the National Competency Standards Framework for Pharmacists in Australia.
Medication Non-Compliance in Numbers
An American study investigating patient compliance with prescribed medications found that misuse of medicines is responsible for nearly a quarter of a million deaths each year (Pathickal et al. 2016).
The Atlantic found that in the US, in almost 20% of cases prescriptions for medicines are never filled, and furthermore, up to 50% of medicines aren't taken as prescribed (Fung 2012).
A study published by the Annals of Internal Medicine found that America’s non-compliance with medication prescriptions is costing roughly $100 billion to $289 billion, annually (Fung 2012).The Role of the Pharmacist
The role of the pharmacist is constantly growing and being redefined. Pharmacists are essential in verifying that patients have sufficient understanding, knowledge, and skill to follow their pharmacotherapeutic regimens (ASHP 2011).
In addition to this, pharmacists should also seek ways to encourage patients to learn about their treatment and to be involved as active partners in their care (ASHP 2011).
Pharmacists play a central role in ensuring medication safety and compliance across the continuum of care. The complexity of the medication prescribing and delivery processes can make it hard to prove the positive effect that pharmacists have on adverse outcomes directly.
This challenge aside, studies have shown that pharmacist involvement has the potential to:
- Reduce errors;
- Improve prescribing practices; and
- Enhance patient monitoring across different settings.
(Patient Safety Network 2019)
Lack of sufficient knowledge about their health problems and medicines is a leading cause of patients’ non-adherence to treatment plans (ASHP 2011).
It’s an issue to be taken very seriously. Medicine non-compliance not only creates problems for health professionals overseeing treatment, but also has the potential to cause death. For example, a patient with congestive heart failure who does not take diuretics correctly on a regular basis will likely end up in hospital repeatedly (Fung 2012).
Patient counselling at the pharmacy counter is a practised skill. Arguably, assuring that the patient understands the treatment is as critical to the role as filling prescriptions accurately.
If a medicine is not properly discussed with a pharmacist, the person leaves the pharmacy with only the directions on the medication label and an information pamphlet.
What is Required to Provide Effective Counselling?
Allocating appropriate time for each patient is crucial to effective counselling. Each and every patient should understand why they are taking a medicine and exactly how it should be taken (Pathickal et al. 2016).
With a community setting that has largely become like a business, pharmacists must do what they can to try to make themselves available to the patients (Pathickal et al. 2016).
Open-ended questioning and active listening are essential skills for sharing information with patients, and obtaining information from them as well.
Pharmacists may need to adapt medicine counselling to suit patients’ language skills and primary languages. This can be achieved through the use of teaching aids, interpreters, or cultural guides if necessary.
Pharmacists also need to observe and interpret the nonverbal messages (e.g., eye contact, facial expressions, body language, vocal characteristics) that patients give during counselling (ASHP 2011)
The Essential Components of Patient Counselling (DRUG)
Leuck (2015) endorses the DRUG acronym to assist pharmacists in remembering the vital components of patient counselling.
1. D - Dosage
- The dose of the medicine and how often it should be taken;
- Potential timing issues associated with dosage;
- What to do if a dose is missed.
2. R - Results
- What the person can expect while taking the medicine;
- How the drug works in the body;
- How the person can tell if the medicine is working; and
- The potential consequences of non-adherence.
3. U - Underlying issues
- Does the medicine have Black Box warnings?
- Is the person allergic to this medicine?
- Is the person taking other medicines that could interact with this medicine?
- Does this medicine react to alcohol, particular foods, or sunlight?
- Are there specific precautions for elderly, young, pregnant or breast-feeding persons?
- Any other medicine specific cautions or precautions.
4. G - General information
- Assess the person’s understanding of the above;
- Discuss how to properly store this medicine;
- Discuss information regarding refills;
- How to dispose of unused medicines; and
- Who they can call if they have any questions.
An active counselling role not only facilitates a clearer understanding of medicines but also plays an important role in emphasising the necessity of medication adherence (Pathickal et al. 2016), which could have a positive life-long influence on the patient.
It is vital for both the community and pharmacists themselves to understand and appreciate the role they play in managing a patient’s health (Pathickal et al. 2016).
Multiple Choice Questions Q1. Fill in the blank: A US study found that …% of prescriptions are never filled.
- American Society of Health-System Pharmacists (ASHP) 2011, ‘ASHP Guidelines on Pharmacist-Conducted Patient Education and Counseling’, ASHP, viewed 3 February 2020, https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/pharmacist-conducted-patient-education-counseling.ashx
- Fung, B 2012, ‘The $289 Billion Cost of Medication Noncompliance, and What to Do About It’, The Atlantic, viewed 3 February 2020, https://www.theatlantic.com/health/archive/2012/09/the-289-billion-cost-of-medication-noncompliance-and-what -to-do-about-it/262222/
- Leuck, S 2015, ‘Patient Medication Counselling Tool for Pharmacists’, Pharmacy Times, viewed 3 February 2020, https://www.pharmacytimes.com/contributor/steve-leuck-pharmd/2015/02/patient-medica tion-counseling-tool-for-pharmacists
- Pathickal, S, Patel, R and Swanby, S 2016, ‘The Importance of Counseling and its Impact on Medication Adherence’, Rho Chi Post, viewed 3 February 2020, https://rhochistj.org/RhoChiPost/importance-counseling-impact-medication-adherence/
- Patient Safety Network, ‘The Pharmacist’s Role in Medication Safety’, Patient Safety Network, viewed 3 February 2020, https://psnet.ahrq.gov/primer/pharmacists-role-medication-safety
- Pharmacy Board of Australia 2015, 'Guidelines for Dispensing Medicines', Pharmacy Board of Australia, viewed 3 February 2020, https://www.pharmacyboard.gov.au/codes-guidelines.aspx
- World Health Organization n.d., ‘The Role of the Pharmacists in the Health Care System’, WHO, viewed 4 February 2020, https://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.2.html
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